Navigation Links
Southern Medical Association Takes Position on Breast Cancer Screening
Date:1/17/2010

As an organization that has historically championed the well being of patients by advocating for physician patient relationships which ensure optimal patient care and well being, the Southern Medical Association (SMA) urges caution in the development, interpretation, and presentation of guidelines such as breast cancer screening that can negatively impact patients.

(PRWEB) January 17, 2010 -- The physician must be responsible for treating the individual patient. Guidelines that are based on data that excludes certain groups that comprise a significant number of our patient population must not be viewed as universally accepted practice. It is up to concerned physicians to make certain that employers, policy makers, regulators, and the public are aware of these critical limitations, and to continue to advocate for their patients, as individuals.

R. Bruce Shack, M.D., President, Southern Medical Association
Michael C. Gosney, M.D., J.D., M.B.A., Chair, Coordinating Committee on Advocacy

Breast Cancer Screening: who will advocate for the patient?

In November 2009, the U.S. Preventive Services Task Force issued breast cancer screening recommendations. These recommendations were based on a case-based analysis, and were “intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services.” It quickly became apparent that these recommendations and the accompanying suggestions for practice would not be universally accepted by clinicians or the public in general, and many quickly rose up to cite these recommendations as the first wave of health care rationing that could become ubiquitous under health care reform.

Physicians strive to provide the best care possible for their patients. The Task Force provides information to inform clinical decisions related to cancer screening. The clinician is concerned with the individual patient, whereas the Task Force is concerned with populations and whether definitive evidence exists to support screening within certain demographic groups. A lack of evidence to support screening for a particular group does not necessarily mean that such screening is not beneficial; it means that there is simply no controlled study (discounting anecdotal evidence of which we are all aware) to support screening for that particular portion of the patient population. In the absence of clear and timely data, recommendations should be withheld or qualified.

The Task Force admits that the study upon which the recommendations are based has certain limitations. These limitations are likely to be more significant for some clinicians and their patients, depending on the region of the country in which they practice and the individual patients who populate their practices. In particular, women with a genetic susceptibility or family history of breast cancer and black women are not included in the cohort upon which these recommendations are based. These women have a higher risk of breast cancer and of more aggressive types of breast cancer, and would benefit from more frequent screening and screening at a younger age. Making a broad statement about screening without addressing these alternate populations is hazardous.

The Task Force states that their recommendations are in part meant to limit unanticipated, negative consequences of routine mammograms including patient anxiety, false –positive results, biopsies in patients without cancer and diagnosis of lesions that may not be clinically significant. A recent study, not referenced by the Task Force, by Gierisch et al evaluated factors and barriers associated with yearly mammogram screening compliance in women aged 40-49. They found 26.1% of women were nervous about the results of mammograms. However there were other competing reasons for annual noncompliance, including “not thinking mammograms are necessary” (12.6%), “too busy” or “forgot” (40% and 43.3% respectively). The well published controversies and ambiguous recommendations for screening mammography of women in their 40’s could also result in noncompliance for these patients, including those patients for whom screening is indicated based on their individual family history, genetics, or ethnic origin. This is another important “unquantifiable” consideration that we as health professionals must consider when evaluating Task Force recommendations and their unintended consequences.

It is critical that we carefully examine the limitations of these recommendations and their unintended consequences, and as physicians, consider how the recommendations apply on an individual patient basis. It is also critical that payers are aware of these limitations, so that patients who need screening outside of recommended guidelines will still be covered. Future recommendations and/or guidelines should be applicable to all patient populations, or should qualify within the recommendation itself the patient population to which it applies. The U.S. Preventive Services Task Force has provided clinicians, employers, policy makers, and regulators with information that may potentially result in denial of breast screening to patients who would benefit from screening. It is up to concerned clinicians to make certain that employers, policy makers, regulators, and the public are aware of these critical limitations, and to continue to advocate for their patients.

Peter Kragel, M.D., Professor and Chair, East Carolina University Brody School of Medicine

Lisa Bellin, M.D., Clinical Associate Professor, East Carolina University Brody School of Medicine

*The Southern Medical Association is a multi-specialty physician based professional association which has provided post graduate continuing medical education and development to physicians since 1906. For more information visit www.sma.org.

REFERENCES
Mandelblatt JS, Cronin K, Bailey S, Berry D, Konin H, Draisma G ,Huang H, Lee S, Munsell M, Plevritis S, Ravdin P, Schechter C, Sigal B, Stoto M, Stout N, Ravesteyn N, Venier J, Zelen M, Feuer E. Effects of mammography screening under different screening schedules. Model estimates of potential benefits and harms. Ann Intern Med 2009;151:738-747
Mandelblatt JS, Liang W, Sheppard VB, Wang J, Isaacs C. Breast cancer in minority women. In: Harris J, Lippman M, Morrow M, Osborne CK, eds. Diseases of the Breast. 4th ed. Philadelphia: Lippincott Williams & Wilkin; 2009.
Buist DS, Porter PL, Lehman C, Taplin SH, White E. Factors contributing to mammography failure in women aged 40-49 years. J Natl Cancer Inst 2004;96:1432-40. [PMID: 15467032
Weinstein MC, O'Brien B, Hornberger J, Jackson J, Johannesson M, McCabe C, et al; ISPOR Task Force on Good Research Practices—Modeling Studies. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices—Modeling Studies. Value Health 2003;6:9-17. [PMID: 12535234
Gierisch JM, O'Neill SC, Rimer BK, DeFrank JT, Bowling JM, Skinner CS.Factors associated with annual-interval mammography for women in their 40s. Cancer Epidemiol. 2009 Jul;33(1):72-8. Epub 2009 May 29.

# # #

Read the full story at http://www.prweb.com/releases/2010/01/prweb3456124.htm.


'/>"/>
Source: PRWeb
Copyright©2010 Vocus, Inc.
All rights reserved

Related medicine news :

1. Southern Tier HealthLink NY Selects InterComponentWare to Deliver Core Components of HIE
2. Celebrate A New Life, Christian Drug Rehab Program, Major Expansion in Southern California
3. SouthernLINC Wireless Selects 2009 Southern Heroes
4. Leading Southern California Physicians Report Patient Fears About Complexities of Flu Season
5. Renowned Southern California Doctors Emphasizing Early Detection During Breast Cancer Awareness Month
6. Southern California Renaissance Laser and Vein Institute (laserandveinclinic.com) Offers Cutting Edge New Titan Procedure
7. Capital Gold Group Donates to American Red Cross Disaster Relief for Victims of Southern California Wildfires
8. Aethlon Medical to Present at Todays Southern California Investor Conference
9. Los Angeles Criminal Defense Attorneys Secure Insanity Verdicts in Two Southern California Murder Cases
10. Southern California Surgical Center (heart411.com) Specializes in Mitral Valve Replacement
11. Leukemia/Lymphoma Society Pleased to Announce Partnership in Southern Ohio with Eisen Marketing Group
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... ... ... Conventional wisdom preaches the benefits of moderation, whether it’s a matter of ... too high can result in disappointment, perhaps even self-loathing. However, those who set the ... Research from PsychTests.com reveals that behind the tendency to set low expectations ...
(Date:6/24/2016)... ... , ... June 19, 2016 is World Sickle Cell Observance Day. In an ... of holistic treatments, Serenity Recovery Center of Marne, Michigan, has issued a ... Cell Disease (SCD) is a disorder of the red blood cells, which can cause ...
(Date:6/24/2016)... ... ... Global law firm Greenberg Traurig, P.A. announced that 20 Florida attorneys are recognized ... this recognition are considered among the top 2 percent of lawyers practicing within the ... this year’s Legal Elite Hall of Fame: Miami Shareholders Mark D. Bloom, Burt ...
(Date:6/24/2016)... ... ... Topical BioMedics, Inc, makers of Topricin and MyPainAway Pain Relief Products, join The ‘Business for ... $12 an hour by 2020 and then adjusting it yearly to increase at the same ... wage, assure the wage floor does not erode again, and make future increases more predictable. ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... ... Living, is proud to recognize Dr. Barry M. Weintraub as a prominent plastic ... most beautiful women in the world, and the most handsome men, look naturally ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... , June 23, 2016 The vast ... an outpatient dialysis facility.  Treatments are usually 3 times ... hours per visit, including travel time, equipment preparation and ... patient, but especially grueling for patients who are elderly ... a skilled nursing and rehabilitation centers for some duration ...
(Date:6/23/2016)... Tenn. , June 23, 2016 /PRNewswire/ ... automating, integrating and transforming the patient payment ... of several innovative new products and services ... of its revenue cycle offerings. These award-winning ... more efficient workflows, remain compliant in an ...
(Date:6/23/2016)... -- The National Pharmaceutical Council (NPC) today announced that ... organization as its newest member.  ... and chief scientific officer, Mallinckrodt Pharmaceuticals, will serve ... of Directors. ... in support of our efforts to conduct research ...
Breaking Medicine Technology: